NCC202256_Contact Update Record (Legally Resp Change)_20230217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 2/17/2023 3:37:58 PM (Contact Changes Submitted)

Certificate of NCC202256
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-2256
Original NOI No.* 26276
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Steeplegate Village, LLC
Project Name Steeplegate Village Phase 2
Address Finch Farm Road, Trinity, NC
County Randolph
Latitude 35.8611
Longitude-80.0346
Date COC Issued * 06/03/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* • Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Christopher Lyons
Individual (Previous)
First Name (New)* Christopher
Last Name (New)* Dunbar

NEW Legally Reflects any revisions above
Responsible Christopher Dunbar
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5826 Samet Drive, Suite 105, High Point, NC
Address (Previous) 27265
NEW Permittee Street Address
Mailing Address* 5826 Samet Drive
Address Line 2
Suite 105
City
State / Province / Region
High Point
NC
Postal / Zip Code
Country
27265
USA
Permittee Street 5826 Samet Drive, Suite 105, High Point, NC
Address (Previous) 27265
NEW Permittee Street Street Address
Address* 5826 Samet Drive
Address Line 2
Suite 105
City
State / Province / Region
High Point
NC
Postal / Zip Code
Country
27265
USA
Change Requested Christopher Dunbar via Modification request submitted 2/9/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 02/17/2023